Healthy Aging in Neighborhoods of Diversity across the ...€¦ · The Dietary Supplements section provides personal interview data on use of over the counter and prescription vitamins,

Healthy Aging in Neighborhoods of Diversity across the Life Span Study

Dietary Supplement Documentation Codebook

First Published: July 2007 Revised: January 2013

Revised: July 2015 Revised: August 2020

Dietary Supplements Page 1 of 78

HANDLS 2007 Documentation Questionnaire Section: Sample Person Interview

WAVES of Coverage: Wave 3, Wave 4

Component Description

The Dietary Supplements section provides personal interview data on use of over the counter and prescription vitamins, minerals, and antacids and other dietary supplements. This section also includes supplement name, ingredients, amounts, and serving size.

Eligible Sample

All sample persons (SP). Survey participants are 30 to 64 years of age at baseline.

Mode of Administration

Appendices

Telephone interview.

File 1: Supplement Counts File 2: Supplement Records File 3: Supplement Information File 4: Ingredient Information File 5: Supplement Blend 1. Wave 3 Supplement Questionnaire 2. Wave 4 Supplement Questionnaire 3. Matching Codes 4. NHANES Created Default Supplements and Antacids 5. Source of Supplement Information 6. Formulation Type 7. Rules for Classifying Ingredients 8. Reported Dosage Units 9. Reasons for Taking Supplements 10. Label Serving Size Units 11. Ingredient Units 12. Ingredient Classification 13. Description of Statistical Analysis to Create Supplemental Nutrient File

Data Files


Data Collection For the exact questions participants are asked see Appendix 1:

Dietary Supplements Questionnaire. During a telephone interview, researchers administer a computer based dietary supplement questionnaire following the completion of the 24 hour dietary recall. Survey participants are asked if they have taken any over the counter or prescription vitamins, minerals, and antacids or any other dietary supplement in the previous 24 hours. Those who answer “yes” are asked to get the dietary supplement containers of all the products used.

For each dietary supplement reported, the interviewer enters the product’s complete name from the container into a computer. If no container is available, the interviewer asks the participant to verbally report the name of the dietary supplement. The interviewer enters all the information into the questionnaire. The manufacturer is entered manually for less commonly known products. The process is repeated for non-prescription antacids. The process is then repeated for prescription vitamin/minerals and antacids.

Participants are asked how long they have been taking the dietary supplement and how much they take daily. Participants are also asked for what reason the supplement is taken, and if the supplement is recommended by a doctor.


Data Matching a reported supplement to known supplement: Processing Trained nutritionists match the product names entered and Editing (including prescription supplements and antacids containing calcium

or magnesium) to a known product when possible. These matches are made with varying degrees of precision, and a matching code (MATCH) accompanies each match (Appendix 3: Matching Codes). Briefly, the codes are: 1) Exact or near exact match; 2) Probable match; 3) Generic match; 4); Reasonable match; and 5) Default match. In some cases no match can be made with any certainty. These products are coded 6) No match. Products whose names were reported as “Refused” or “Don’t know” have matching codes of 7 and 9, respectively.

Nutritionists communicate with many major manufacturing company representatives to determine when various product re-formulations become available. Reported supplements are matched with known supplements based upon reported supplement name as entered by the interviewer and the product version on the market at that time, if known. Based upon manufacturer advice, a lag time of 5 months after new product market entry is used in matching recorded products to these new products. Despite these precautions, there is no guarantee that the product taken was not an older or newer product than the one to which it was matched.

Generic and default dietary supplements were created and entered into the supplement database. Reported supplements for which the strength of all ingredients was known were matched to a generic supplement, i.e. one which had no brand name. These were generally single ingredient supplements which included a strength (e.g. vitamin C 500 mg) or multiple vitamins and/or mineral supplements made by a private label manufacturer that was known to us and for which we had a label with identical ingredients and strengths (e.g. brand X all-purpose multivitamin was reported, and we had a label for brand Y, made by the same manufacturer). These matches are coded as 3. When all ingredient strengths were not known, the supplement was matched to a default supplement where possible. Defaults were created for single ingredient and multiple ingredient supplements based on NHANES data that matches the year of HANDLS study data collection of most frequently reported supplements of that type. These matches were coded as 5. Created default and generic products and the actual products or strengths that were assigned to these defaults are listed in Appendix 4: NHANES created default supplements and antacids).

Dietary Supplements Database Overview: HANDLS attempts to obtain a label for each supplement reported by a participant from sources such as the manufacturer or retailer, the Internet, company catalogs, and the Physician’s Desk Reference



(PDR). Selected label information is then entered into the HANDLS Dietary Supplement Database including: supplement name; manufacturer; serving size; form of serving size; ingredients and amounts, including an operator to indicate that the amount is less than, more than or equal to the amount. The ingredient information entered into the database is taken directly from the supplement facts box on the label or carton, if available, or the equivalent from other sources.

HANDLS does not verify the actual composition of supplements reported: the database is based on label information, not testing. The best information source is the label itself, but when this cannot be obtained, other sources are used. Information from other sources may not always be an accurate reflection of what is actually on the supplement label. This is true for the supplement’s apparent name as well as for the ingredients. Differences from what appears on the label are particularly noted for information from the Internet (name and ingredients), the PDR (name), and supplement carton (name). In addition, supplements may change the appearance of a label and thus the apparent name without changing the content or may change content with minimal change to the label, or may change both. The source of the supplement information is included in the data release. (See Appendix 5: Source of Supplement Information.)

Some supplements contain proprietary blends of ingredients, generally non-nutrients. Usually an amount is specified for the blend but not individual ingredients. In such cases, the blend and its amount are entered into the database, but the individual ingredients of the blend are listed without any amounts. A few supplement labels list ingredients but no amounts at all, so the amounts are missing.

Additional information about the supplement is entered by nutritionists into the database. 1. Supplement formulation type (standard, mature, and

and prenatal: Appendix 6) is based upon the appearance of the label or specific wording indicating the targeted users.

2. Ingredients are classified as vitamin; mineral; amino acid; botanical; fiber; fat; carbohydrate; or other (Appendix 7: Rules for classifying ingredients). Of particular note is that we have classified the ingredient beta- carotene as “other,” not a vitamin. This ingredient information is later tallied to provide the number of ingredients of each type in the supplement.

3. Generic and default supplements are also entered into the database to be matched with supplements for which brand-specific matches cannot be made.


Specific Variables and Edits

MATCH: (matching code): Supplements are recorded in the telephone interview with varying degrees of accuracy and completeness, so a system to determine how certain a supplement recorded during the interview matches with the actual supplement label. Briefly, the codes are: 1) Exact or near exact match; 2) Probable match; 3) Generic match; 4); Reasonable match; and 5) Default match. In some cases no match can be made with any certainty. These products are coded 6) No match. Products whose names were reported as “Refused” or “Don’t know” have matching codes of 7 and 9, respectively.

Note: Analysts should be aware that for default matches and matches that chose between several similarly named supplements, there is less certainty that the ingredients and ingredient amounts in the supplement assigned exactly match those in the supplement actually taken. Additionally, HANDLS cannot guarantee in any case that the matched product was the exact product taken or even that any product actually was taken, as these data are self-reported. CNTOTCVIT - total number of nonprescription vitamin/mineral supplements taken per respondent. CNTANTA - total number of non-prescription antacids taken per respondent. CNTRXN - total number of prescription vitamin/mineral supplement and antacids taken per respondent. CONTAINER - denotes if the dietary supplement container was available during the telephone interview. LENGTH - (How Long Supplement Taken) is converted to days for release by multiplying years by 365; months by 30.4; and weeks by 7. QUANTITY/DOSE - Quantity and reported dosage form (Appendix 8) of supplement taken daily as recorded by interviewer. REASON – Reasons for taking supplement (Appendix 9).


Variables from the Dietary Supplement Database SUPID (Supplement ID Number) These are numbers assigned by staff for each product entered. Note: All Supplement ID numbers are 10 digits long.

All NHANES Supplement IDs begin with the number ‘1’. The next 3 digits (positions 2-4) are ‘888’ if the supplement was created by NCHS as a generic or default product; otherwise the digits in positions 2-4 are coded ‘000’. The next 4 digits (positions 5-8) are assigned by NHANES staff and do not indicate anything about the product. The last 2 digits (positions 9-10) indicate formulations of the same supplement. The first formulation entered into the database = 00, the first reformulation = 01, the next = 02, etc. Note that these are reformulations of the same product: different versions (e.g. liquid vs. tablet, with iron vs. without iron, regular vs. high potency) have different 4 digit numbers (positions 5-8).

For HANDLS supplements the Supplement ID begins with a ‘4’. The next 3 digits (positions 2-4) are ‘888’ if the supplement was created by HANDLS as a generic or default product; otherwise the digits in positions 2-4 are coded ‘000’. The next 4 digits (positions 5-8) are assigned using the following criteria and identify the category of the product. The list below defines of what each number in the fifth position means.

If the fifth number is: 1- over-the-counter multivitamin/mineral 2- over-the-counter single or double element 3- fish oils 4- over-the-counter antacids 5- prescription vitamin/mineral supplement 6- prescription antacids 7- herbals/botanicals 8- laxatives 9- weight loss supplements

Positions 6-8 are used to enter a unique code for individual products. The last 2 digits (positions 9-10) indicate formulations of the same supplement product. The first formulation entered into the database = 00, the first reformulation = 01, the next = 02, etc. Note that these are reformulations of the same product and same form.

SUPP (Name of Supplement) This is the name from the supplement front label which is entered into the database. Matching the supplement from the interviewers’ record to an actual product label is made with varying degrees of certainty. Product names that were entered as “refused” or “don’t know” are named “7” and “9”, respectively.

Note: For some entries made by interviewers, no corresponding product label could be found nor could a reasonable default product be


assigned. These entries are counted as supplements, since there is no evidence that they are not supplements. The MATCH code was entered as a “6”.

Note: HANDLS collects brand name information on supplements whenever feasible, to ensure as much accuracy as possible in finding the label information for the exact product taken, and providing exact ingredient information for this product to data users. Products with very similar names but manufactured by different companies may contain different ingredient strengths.

Brand names are released for supplements matched with a high degree of product or brand certainty, as this information may be useful in the design of other surveys. However matching of brand names to reported products may contain errors, and many matches are made to generic or default products, especially for private label brands. Thus, analyses of consumer usage by brand name using HANDLS data may not be accurate and is not recommended.

SOURCE (Supplement Information Source) The source of each product label is recorded into the database. These source codes are listed in Appendix 5. Generic and default products do not have a source code.

FORM (Formulation Type) The type of formula is recorded into the database. These codes are listed in Appendix 6.

SERVQ (Serving Size Quantity) This is the “product dosage quantity”, which is recorded from the product label supplements facts panel. Note: When calculating the amount of a nutrient consumed from supplements, it is important to take serving size into consideration. For some supplements, the serving size may be more than one tablet, drop, teaspoon, etc. In such cases, a person taking only one tablet, for example, would only be getting a percentage of the amount listed for that ingredient. In addition, the ingredient listed may be a compound (e.g. calcium carbonate), only the amount of elemental mineral was included in the database.

SERVUNIT (Serving Size Unit) This is the “serving size unit”, which is recorded from the product label supplements facts panel. The codes are listed in Appendix 10.

SERVA (Alternative Serving Size) This is listed in labels for some products. Not all products offer an alternative serving size. Label may include alternative serving size (e.g. 1 dropperful = 1 mL).


INGID (Ingredient ID) This is the ingredient ID created in our database for each ingredient recorded from the product label supplements facts panel.

INGR (Ingredient name) Ingredient names are recorded from the product label supplements facts panel.

INGOPER (Ingredient operator) This is a symbol =, <, or > that comes from the product label supplements facts panel.

INGQTY (Ingredient quantity) Ingredient quantity is recorded for each ingredient listed from the product label supplements facts panel.

INGUNIT (Ingredient unit) Ingredient unit is recorded for each ingredient listed from the product label supplements facts panel. Appendix 11 lists the code for these.

INGCAT (Ingredient category) There are ingredient categories: Vitamin, Mineral, Botanical, Amino Acid, Fat, Fiber, Carbohydrate, and Others. These are assigned by HANDLS nutritionists. Appendix 12 lists the code for these. CNTVIT : number of vitamins in the product CNTMIN : number of minerals in the product CNTAA : number of amino acids in the product CNTBOT : number of botanicals in the product CNTFAT : number of ingredients classified as fat in a product CNTCHO : number of carbohydrates and sugars in the product CNTFIBER : number of fiber elements in a product. CNTO : number of other ingredients in the product

Note: For each supplement, this is the number (count) of ingredients in each ingredient category (vitamin, mineral, amino acid, botanical, fat, fiber, carbohydrate, and other) listed in the facts box on the label, including ingredients listed within blends. In a few products with blends, the same vitamin or mineral was listed as both an ingredient with an amount and as part of a blend. In these cases, only the


vitamin or mineral was only counted as one.


Quality Assurance & Quality Control Procedures

BLENDFLAG (Blend Flag) This indicator variable denotes whether an ingredient is a blend or not a blend.

BLENDID (Blend component id) These are ingredient ID numbers for blend ingredients.

BLENDNAME (Blend component name) These are ingredient names for blend ingredients. Blends in products will not give the actual breakdown of ingredient quantities in the blend. The ingredients will usually just be listed, and most of the time a whole blend amount is given.

BLENDCAT (Blend component category) There are ingredient categories for each blend ingredient: Vitamin, Mineral, Botanical, Others, Amino Acid. These are assigned by NCHS staff. Appendix 7 lists the code for these.

Trained nutritionists reviewed incoming data and matched reported to known supplements from the NHANES and HANDLS database, where possible; sought additional supplement labels if feasible; assigned generic or default supplements as appropriate; and assigned matching codes as described in Appendix 3: Matching Codes. Scheduled coding meetings were held with the supervisor, who has a PhD in nutrition and is an RD, to discuss coding questions. All coding was reviewed by the coding supervisor and adjusted as necessary.


Data Files and The data relating to dietary supplements are included in five Structure separate files. The files can be linked by respondent id, supplement

id, or ingredient id. This structure is used to avoid unwieldy record length. The content of each file is described below.

File 1: Supplement Counts

Variable Name Label HANDLSID Respondent ID number WAVE Wave number INTERVIEW Interview number OTCVIT Any OTC dietary supplements

taken? CNTOTCVIT Total # of dietary supplements

taken ANTA Any non-prescription antacids

taken? CNTANTA Total # of non-prescription

antacids taken RXN Any prescription vitamins,

minerals, antacids taken? CNTRXN Total # of prescription

vitamins, minerals, antacids


File 2: Supplement Records

Variable Name Label

HANDLSID Respondent ID number

WAVE Wave number

INTERVIEW Interview number

SUPPID Supplement ID number

SUPP Supplement name

CONTAINER Was container seen?

MATCH Matching code (Appendix 3)

LENGTH How long supplement taken (days)

QUANTITY Quantity of supplement taken per day

DOSE Dosage units (Appendix 8)

REASON Reasons for taking supplement (Appendix 9)


File 3: Supplement Information

Variable Name Label SUPPID Supplement ID number SUPP Supplement name SOURCE Supplement information source

(Appendix 5) FORMTYPE Formulation type (Appendix 6) SERVQ Serving size quantity SERVUNIT Serving size unit (Appendix 10) SERVA Alternative serving size CNTVIT Count of vitamins in the

supplement CNTMIN Count of minerals in the

supplement CNTAA Count of amino acids in the

supplement CNTBOT Count of botanicals in the

supplement CNTO Count of other ingredients in the

supplement

File 4: Ingredient Information

Variable Name Label SUPPID Supplement ID number SUPP Supplement name INGID Ingredient ID INGR Ingredient name INGOPER Ingredient operator (<,=,>) INGQTY Ingredient quantity INGUNIT Ingredient unit (Appendix 11) INGCAT Ingredient category (Appendices 7

and 12) BLENDFLAG Blend flag VERIFIED Date when quantities of ingredients checked


File 5: Supplement Blend

Variable Name Label INGID Ingredient ID number INGR Ingredient name BLENDID Blend component ID BLENDNAME Blend component name BLENDCAT Blend component category


Appendices

Appendix 1: Wave 3 Supplement Questionnaire

HANDLS OVER-THE-COUNTER AND PRESCRIPTION DIETARY SUPPLEMENTS QUESTIONNAIRE

SP NAME: HH ID: INTERVIEW: DATE: Interviewer: First, if you have any bottles or containers of any over the counter and prescription supplements or antacids, I would like to ask you to get them if you do not have them in front of you for this part of the interview. Do you have any questions before we begin? Q.1 All day yesterday, between midnight and midnight, did you take any over the counter vitamin and/or mineral supplements?

Circle: YES or NO If yes, list the names Names of OTC Supplements (at least 10 fields) _____________________________

Q.2 All day yesterday, between midnight and midnight, did you take any nonprescription antacids? (such as rolaids, tums, or pepsid AC?)

Circle: YES or NO If yes, list the names Name of Antacids (at least 5 fields)

Q.3 All day yesterday, between midnight and midnight, did you take any prescription vitamins and/or minerals, antacids, or receive any prescription supplement injections? Circle: YES or NO If yes, list the prescription supplements and antacids Name of Prescription Supplements and Antacids (at least 10 fields) Q.4 Do you have the containers for all the OTC vitamins and minerals that you’ve used available in front of you? (If NO ask SP to go get the containers)

YES ................................................................ 1 NO ................................................................. 2 REFUSED ...................................................... 7 DON'T KNOW ………………………………… 9

Interviewer Instructions: First I am going to ask you some questions about (INSERT NAME OF OTC SUPPLEMENT) that you took yesterday. Q. 5 What appears on the front label of the supplement you took, please include the brand name? Interviewer Instruction: Refer SP to handcard 1. Can you please read me all the words on the front label? Was it a special type? (silver, women’s, men’s, prenatal, liquid)?

Q5.1a…f. text boxes w/ unlimited space ______ ENTER SUPPLEMENT NAME

REFUSED ................................................................................................ 7 DON'T KNOW .......................................................................................... 9

HANDLS 2007


Probe if brand name unknown SINGLE ELEMENTS VITAMIN A ................................................................................................ 10 VITAMIN B6 .............................................................................................. 12 VITAMIN B12 ............................................................................................ 13 VITAMIN C (WITH OR WITHOUT ROSE HIPS) ....................................... 14 VITAMIN D................................................................................................ 15 VITAMIN E ................................................................................................ 16 CALCIUM ................................................................................................. 18 CHROMIUM (CHROMIUM PICOLINATE) ................................................ 19 FOLATE (FOLIC ACID) ............................................................................ 20 IRON (FERROUS XXXATE) ..................................................................... 21 MAGNESIUM............................................................................................ 27 POTASSIUM............................................................................................. 28 SELENIUM ............................................................................................... 29 ZINC (ZINC GLUCONATE) ...................................................................... 40 MULTI ELEMENTS VITAMINS A & D ...................................................................................... 50 CALCIUM & VITAMIN D ........................................................................... 51 CALCIUM & MAGNESIUM ....................................................................... 52

Q.6 ENTER MANUFACTURER/DISTRIBUTOR/STORE BRAND NAME. ENTER AS MUCH INFORMATION AS POSSIBLE.

Q6.1a…f ___________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9

Q.7 ENTER CITY NAME. {ENTER AS MUCH INFORMATION AS POSSIBLE}

Q7.1a…f ___________________________

REFUSED ...................................................... 7 DON’T KNOW ................................................ 9

Q.8 ENTER STATE NAME. {ENTER 2-LETTER STATE ABBREVIATION} Q8.1a…f ___________________________

REFUSED ...................................................... 7 DON'T KNOW ................................................ 9


Q.9 What is the form of the supplement taken as stated on the container? (Ex: pill, tablet, liquid etc.)Interviewer Instructions : Write in code corresponding to product name

Q9.1a…f ___________________________

Label Code Caplet 1 Capsule 2 Dropper 3 Drop 4 Fluid Ounce 5 Gel Cap 6 Injection/Shot 8 Lozenge 9 Milliliter 10 Package/Packet 12 Pill 13 Tablespoon/Powder 14 Softgel 16 Tablespoon/Liquid 17 Tablet 18 Teaspoon/Liquid 19 Wafer 20 Ounce/Powder 21 Spray/Squirt 22 Scoop/Powder 24 Cup/Powder 25 Chew 27 Other 28 Vegicap 29 Can/Liquid 30 Capful 31 Gumball 32 Gram/Powder 33 Teaspoon/Powder 34 Can/Powder 35 Scoop/Liquid 36 Cup/Liquid 37 Gram/Liquid 38 Drop/Lozenge 39 Unknown Dosage Form 99


Q.10 What was the strength per tablet/pill/etc? Interviewer Instruction: Please if it is a double/triple element ask for the strength of each element. (Check the front label or the nutrition; if there is no information on the front label, check the nutrition facts)

Q10.1a…f __________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9


Q.11 Between midnight and midnight, how much of a dose did you take? (Ex: 2 gelcaps) *List number of supplements taken and then form listed below.

*Number taken, then type. (Example: 4, 6 = means they took 4 lozenges)

Q11.1a…f __________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9 TABLETS/CAPSULES/PILLS/CAPLETS/

SOFTGELS/GEL CAPS/VEGICAPS/ CHEWABLE TABLETS ............................... 1

DROPPERS ................................................... 2 DROPS .......................................................... 3 INJECTIONS/SHOTS .................................... 5 LOZENGES/COUGH DROPS ....................... 6 MILLILITERS ................................................. 7 POWDER/GRANULES .............................. … 10 TABLESPOONS ............................................ 11 TEASPOONS ................................................ 12 WAFERS ....................................................... 13 CANS ............................................................. 15 GRAMS .......................................................... 16 DOTS ............................................................. 17 CUPS ............................................................. 18 SPRAYS/SQUIRTS ....................................... 19 CHEWS/GUMMIES ....................................... 20 SCOOPS ....................................................... 21 CC ................................................................. 22 CAPFULS ...................................................... 23 MG ................................................................. 24 UNITS ............................................................ 25 GULP ............................................................. 26 OUNCES ....................................................... 27 PACKAGES/PACKETS ................................. 28 VIALS ............................................................. 29 GUMBALLS ................................................... 30 OTHER FORM (SPECIFY) ............................ 91 REFUSED ...................................................... 77 DON’T KNOW ................................................ 99


Q.12 For how long have you been taking the supplement? ENTER NUMBER AND UNIT (DAYS, WEEKS, MONTHS OR YEARS)

Q12.1a…f __________________________

_____Days _______Months _______Years Q.13 Have you taken it on a regular basis? YES or NO Q.14 Did you decide to take {INSERT PRODUCT NAME} for reasons of your own or did a doctor or other health

provider tell you to take it? Q14.1a…f __________________________

DECIDED TO TAKE IT FOR REASONS

OF MY OWN ............................................... 1 A DOCTOR OR OTHER HEALTH

PROVIDER TOLD ME TO .......................... 2 REFUSED ...................................................... 7 DON’T KNOW ................................................ 9


Q.15 For what reason or reasons do you take or the doctor or other health professional tell you to take {INSERT PRODUCT NAME}? Interviewer Instructions: Refer SP to Handcard 2

Q151a…f ___________________________

CODE ALL THAT APPLY.

FOR GOOD BOWEL/COLON HEALTH ......... 10 FOR PROSTATE HEALTH ............................ 11

FOR MENTAL HEALTH ................................. 12 TO PREVENT HEALTH PROBLEMS ............ 13 TO IMPROVE MY OVERALL HEALTH ......... 14 FOR TEETH, PREVENT CAVITIES .............. 15 TO SUPPLEMENT MY DIET (BECAUSE

I DON’T GET ENOUGH FROM FOOD) ...... 16 TO MAINTAIN HEALTH (TO STAY

HEALTHY) .................................................. 17 TO PREVENT COLDS, BOOST IMMUNE

SYSTEM ..................................................... 18 FOR HEART HEALTH, CHOLESTEROL ...... 19 FOR EYE HEALTH ........................................ 20 FOR HEALTHY JOINTS, ARTHRITIS ........... 21 FOR SKIN HEALTH, DRY SKIN .................... 22 FOR WEIGHT LOSS ..................................... 23 FOR BONE HEALTH, BUILD STRONG

BONES, OSTEOPOROSIS ......................... 24 TO GET MORE ENERGY .............................. 25 FOR PREGNANCY ........................................ 26 FOR ANEMIA, SUCH AS LOW IRON ............ 27 LACTOSE INTOLERANCE…………………… 28 OTHER SPECIFY .......................................... 91 REFUSED ...................................................... 77 DON’T KNOW ................................................ 99

Q.16 Any other over the counter supplements such as herbals (Echinacea, Ginseng, Ginkgo), fiber supplements (Metamucil, Fibercon, Benefiber), or protein or amino acids (Lysine, Methionine, Tryptophan)? Circle: YES or NO (If yes, repeat questions Q5 – Q15) NON-PRESCRIPTION ANTACIDS Interviewer Instructions: Now I am going to be asking you a few questions about your use of nonprescription antacids. Q.17 Do you have the containers for all nonprescription antacids that you’ve used yesterday available in front of you? (If NO ask SP to go get the containers)


Q. 18 All day yesterday, between midnight and midnight, did you take any nonprescription antacids? (such as rolaids, tums, or pepsid AC?) Circle: YES or NO


Interviewer Instructions: First I am going to ask you some questions about INSERT NAME OF ANATACID) that you took yesterday. Q. 19 Please read me all the words on the front label.

What appears on the front label of the antacid you took? Was it extra strength, regular strength, ultra, maximum?

Interviewer Instruction: Refer SP to Handcard 1 of antacid.

Q19.1a….f _______________________________ ENTER SUPPLEMENT NAME

REFUSED ................................................................................................ 7 DON'T KNOW .......................................................................................... 9 Q.20 ENTER MANUFACTURER/DISTRIBUTOR/STORE BRAND NAME. ENTER AS MUCH INFORMATION AS POSSIBLE.



Q21.1a…f __________________________


Q.22 ENTER STATE NAME. {ENTER 2-LETTER STATE ABBREVIATION} Q22.1a…f __________________________

REFUSED ...................................................... 7 DON'T KNOW ................................................ 9


Q.23 What was the form of the nonprescription antacid taken? (Ex: pill, tablet, liquid etc)

Q23.1a…f __________________________


REFUSED ................................................................ 77 DON’T KNOW .......................................................... 99

Q.24 What was the strength per antacid tablet/pill/etc?



Q.25 Between midnight and midnight, how much of a dose did you take? (Ex: 2 gelcaps) *List number of antacids taken and then form listed below.

*Number taken, then type. (Example: 4, 6 = means they took 4 lozenges) Q25.1a…f __________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9

TABLETS/CAPSULES/PILLS/CAPLETS/




Q.26 For how long have you been taking the supplement? ENTER NUMBER AND UNIT (OF DAYS, WEEKS, MONTHS OR YEARS)

Q26.1a…f __________________________

_______Days _______Months ________Years Q.27 Have you taken it on a regular basis? YES or NO Q.28 Did you decide to take {INSERT PRODUCT NAME} for reasons of your own or did a doctor or other health

provider tell you to take it?

Q28.1a…f __________________________





Q.29 For what reason or reasons do you take or the doctor or other health professional tell you to take {PRODUCT}? Interviewer Instructions: Refer SP to Handcard 2

Q29.1a…f __________________________








Q.30 Any other antacids (such as rolaids, tums, or pepsid AC)? Circle YES or No (If yes repeat Q17 – Q29) If no, proceed to

Q31. PRESCRIPTION VITAMINS, MINERALS AND ANTACIDS Interviewer Instruction: Now I am going to be asking you a few questions about your use of prescription vitamins, and/or minerals, antacids, and supplement injections. Q.31 Do you have the containers for all the prescription supplements that you’ve used yesterday

available in front of you? (If NO ask SP to go get the containers)


Q.32 All day yesterday, between midnight and midnight, did you take any prescription vitamins, minerals, antacids, or receive any prescription supplement injections? Circle: YES or NO


Interviewer Instructions: First I am going to ask you some questions about INSERT NAME OF PRESCRIPTION) that you took yesterday. Q. 33 What appears on the front label of the prescription supplement or antacid you took? Can you please read me all the words on the front label, if available?

Q33.1a….f _______________________________ ENTER SUPPLEMENT NAME

REFUSED..................................................................... 7 DON'T KNOW ............................................................... 9



Q.35 What was the form of the supplement taken? (Ex: pill, tablet, liquid etc.)

Q35.1a…f __________________________

Label Code Caplet 1 Capsule 2 Dropper 3 Drop 4 Fluid Ounce 5 Gel Cap 6 Injection/Shot 8 Lozenge 9 Milliliter 10 Package/Packet 12 Pill 13 Tablespoon/Powder 14 Softgel 16 Tablespoon/Liquid 17 Tablet 18 Teaspoon/Liquid 19 Wafer 20 Ounce/Powder 21 Spray/Squirt 22 Scoop/Powder 24 Cup/Powder 25 Chew 27 Other 28 Vegicap 29 Can/Liquid 30 Capful 31 Gumball 32 Gram/Powder 33


Teaspoon/Powder 34 Can/Powder 35 Scoop/Liquid 36 Cup/Liquid 37 Gram/Liquid 38 Drop/Lozenge 39 Unknown Dosage Form 99


Q.36 What was the strength per prescription tablet/pill/etc? Please if it is a double/triple element ask for the strength of each element.


Q.37 Between midnight and midnight, how much of a dose did you take? (Ex: 2 gelcaps) *List number of prescription supplements taken and then form listed below. *Number taken, then type. (Example: 4, 6 = means they took 4 lozenges)

Q37.1a…f __________________________ REFUSED ...................................................... 7 DON'T KNOW …………………………… 9





Q.38 How long have you been taking the prescription supplement/antacid? ENTER NUMBER AND UNIT (DAYS, WEEKS, MONTHS OR YEARS)

Q38.1a…f __________________________

_______Days _______Months ________Years Q. 39 Have you taken it on a regular basis? YES or NO Q.40 Did you decide to take {INSERT PRODUCT NAME} for reasons of your own or did a doctor or other health

provider tell you to take it? Q40.1a…f __________________________





Q.41 For what reason or reasons do you take or the doctor or other health professional tell you to take {PRODUCT}? Interviewer Instruction: Refer SP to Hand card 2.

Q41.1a…f __________________________








Q.42 Any other prescription supplements or antacids? Circle Yes or No (If yes repeat Q31-41) When list is complete review total number of dietary supplements and antacids and their names with respondent, then proceed to Q43


Q. 43 Who was the main respondent for this interview?

Sample person 1 Mother of sample person 2 Father of sample person 3 Wife of sample person 4 Husband of sample person 5 Daughter of SP 6 Son of SP 7 Friend, partner, non relative 8 Care provider or caretaker 9 Other relative 10 Other, specify 11

Q.44 Who else helped in responding for this interview? Yes 1 No 2 If yes, Sample person 1

Mother of sample person 2 Father of sample person 3 Wife of sample person 4 Husband of sample person 5 Daughter of SP 6 Son of SP 7

Grandchild of SP 8 Friend, partner, non relative 9 Care provider or caretaker 10 Other relative 11 Other, specify 12

Q. 45 Did you or the respondent have difficulty or any comments about this supplement interview?

Yes 1 No 2 If no....questionnaire ends

If yes....What were the reasons for this difficulty or comments about this interview?

Did not understand questions 1 Not familiar with handcards 2 Did not have handcards 3 Poor memory of supplements taken 4 Sick 5 Hearing impairment 6 Telephone connection problems 7 Interruptions 8 Uncooperative/impatient 9 Distracted/uninterested 10 Supplement list may be incomplete (explain in remark box) 11 Unreliable (explain in remark box) 12 Not ascertained 13 Other specify (explain in remark box) 14


Appendix 2: Wave 4 Supplement Questionnaire

HANDLS OVER-THE-COUNTER AND PRESCRIPTION DIETARY SUPPLEMENTS QUESTIONNAIRE

SP NAME: HH ID: INTERVIEW: DATE: Interviewer: First, if you have any bottles or containers of any over the counter and prescription supplements or antacids, I would like to ask you to get them if you do not have them in front of you for this part of the interview. Do you have any questions before we begin? Q.1 Do you take any over the counter vitamin and/or mineral supplements?

Circle: YES or NO If yes, list the names Names of OTC Supplements (at least 10 fields) _____________________________

Q.2 Do you take any nonprescription antacids? (such as rolaids, tums, or pepsid AC?)

Circle: YES or NO If yes, list the names Name of Antacids (at least 5 fields)

Q.3 Do you take any prescription vitamins and/or minerals, antacids, or receive any prescription supplement injections? Circle: YES or NO If yes, list the prescription supplements and antacids Name of Prescription Supplements and Antacids (at least 10 fields) Q.4 Do you take any other over the counter supplements such as herbals (Echinacea, Ginseng, Ginkgo), fiber supplements

(Metamucil, Fibercon, Benefiber), or protein or amino acids (Lysine, Methionine, Tryptophan)?

Circle: YES or NO If yes, list the prescription supplements and antacids Name of Prescription Supplements and Antacids (at least 10 fields) Q.5 Do you have the containers for all the OTC vitamins and minerals that you’ve used available in front of you? (If NO ask SP to go get the containers)


Interviewer Instructions: First I am going to ask you some questions about (INSERT NAME OF OTC SUPPLEMENT) that you took yesterday. Q. 6 What appears on the front label of the supplement you took, please include the brand name? Interviewer Instruction:. Can you please read me all the words on the front label? Was it a special type? (silver, women’s, men’s, prenatal, liquid)?

HANDLS 2007


Q6.1a…f ________________________________ ENTER SUPPLEMENT NAME

REFUSED ................................................................................................ 7 DON'T KNOW .......................................................................................... 9

Probe if brand name unknown SINGLE ELEMENTS VITAMIN A ................................................................................................ 10 VITAMIN B6 .............................................................................................. 12 VITAMIN B12 ............................................................................................ 13 VITAMIN C (WITH OR WITHOUT ROSE HIPS) ....................................... 14 VITAMIN D................................................................................................ 15 VITAMIN E ................................................................................................ 16 CALCIUM ................................................................................................. 18 CHROMIUM (CHROMIUM PICOLINATE) ................................................ 19 FOLATE (FOLIC ACID) ............................................................................ 20 IRON (FERROUS XXXATE) ..................................................................... 21 MAGNESIUM............................................................................................ 27 POTASSIUM............................................................................................. 28 SELENIUM ............................................................................................... 29 ZINC (ZINC GLUCONATE) ...................................................................... 40 MULTI ELEMENTS VITAMINS A & D ...................................................................................... 50 CALCIUM & VITAMIN D ........................................................................... 51 CALCIUM & MAGNESIUM ....................................................................... 52


Q7.1a…f ___________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9


Q8.1a…f ___________________________



Q.8a ENTER STATE NAME. {ENTER 2-LETTER STATE ABBREVIATION}

Q8a.1a…f __________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9

Q.9 What is the form of the supplement taken as stated on the container? (Ex: pill, tablet, liquid etc.)Interviewer Instructions : Write in code corresponding to product name

Q9.1a…f ___________________________




Q.10 What was the strength per tablet/pill/etc? Interviewer Instruction: Please if it is a double/triple element ask for the strength of each element. (Check the front label or the nutrition; if there is no information on the front label, check the nutrition facts)


Q.11 Between midnight and midnight, how much of a dose did you take? (Ex: 2 gelcaps)

*List number of supplements taken and then form listed below. *Number taken, then type. (Example: 4, 6 = means they took 4 lozenges)

Q11.1a…f________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9 TABLETS/CAPSULES/PILLS/CAPLETS/




Q.11A. What is your usual dosage? (Ex: 2 gelcaps)


Q11A.1a…f _________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9 TABLETS/CAPSULES/PILLS/CAPLETS/


DROPPERS ................................................... 2 DROPS .......................................................... 3 INJECTIONS/SHOTS .................................... 5 LOZENGES/COUGH DROPS ....................... 6 MILLILITERS ................................................. 7 POWDER/GRANULES .............................. … 10 TABLESPOONS ............................................ 11 TEASPOONS ................................................ 12 WAFERS ....................................................... 13 CANS ............................................................. 15 GRAMS .......................................................... 16 DOTS ............................................................. 17 CUPS ............................................................. 18 SPRAYS/SQUIRTS ....................................... 19 CHEWS/GUMMIES ....................................... 20 SCOOPS ....................................................... 21 CC ................................................................. 22 CAPFULS ...................................................... 23 MG ................................................................. 24 UNITS ............................................................ 25 GULP ............................................................. 26 OUNCES ....................................................... 27 PACKAGES/PACKETS ................................. 28 VIALS ............................................................. 29 GUMBALLS ................................................... 30 OTHER FORM (SPECIFY) ............................ 91 REFUSED ...................................................... 77 DON’T KNOW 99


Q.12 Did you take it yesterday? YES or NO Q.13 For how long have you been taking the supplement? ENTER NUMBER AND UNIT (DAYS, WEEKS, MONTHS OR YEARS)

Q12.1a(Ex. 3 years)…f _______________

_____Days _______Months _______Years DAYS ............................................................. 1 WEEKS .......................................................... 2 MONTHS ....................................................... 3 YEARS ........................................................... 4 OTHER .......................................................... 5

Q.13A Do you take it daily? YES or NO Q. 13B If NO (not daily), how often? ENTER NUMBER AND UNIT (DAYS, WEEKS, MONTHS, or YEARS) (EX.)

Q13B.1a (EX. 2 days per week)…f _______

Q.14 Did you decide to take {INSERT PRODUCT NAME} for reasons of your own or did a doctor or other health

provider tell you to take it? Q14.1a…f __________________________ DECIDED TO TAKE IT FOR REASONS




Q.15 For what reason or reasons do you take or the doctor or other health professional tell you to take {INSERT PRODUCT NAME}?

Q151a…f ___________________________








Q.16 Any other over the counter over the counter supplements such as herbals (Echinacea, Ginseng, Ginkgo), fiber supplements (Metamucil, Fibercon, Benefiber), or protein or amino acids (Lysine, Methionine, Tryptophan)? Circle: YES or NO (If yes, repeat questions Q5 – Q15) NON-PRESCRIPTION ANTACIDS Interviewer Instructions: Now I am going to be asking you a few questions about your use of nonprescription antacids. Q.17 Do you have the containers for all nonprescription antacids that you’ve used yesterday available in front of you? (If NO ask SP to go get the containers)



Interviewer Instructions: First I am going to ask you some questions about (INSERT NAME OF ANATACID) that you took yesterday. Q. 18 What appears on the front label of the antacid you took?

Please read me all the words on the front label. Was it extra strength, regular strength, ultra, maximum?

Q19.1a…f. _______________________________ ENTER SUPPLEMENT NAME

REFUSED ................................................................................................ 7 DON'T KNOW .......................................................................................... 9 Q.19 ENTER MANUFACTURER/DISTRIBUTOR/STORE BRAND NAME. ENTER AS MUCH INFORMATION AS POSSIBLE.



Q21.1a…f __________________________


Q.21 ENTER STATE NAME. {ENTER 2-LETTER STATE ABBREVIATION}


Q.22 What was the form of the nonprescription antacid taken? (Ex: pill, tablet, liquid etc)

Q23.1a…f __________________________

Label Code Caplet 1 Capsule 2 Dropper 3 Drop 4


Fluid Ounce 5 Gel Cap 6 Injection/Shot 8 Lozenge 9 Milliliter 10 Package/Packet 12 Pill 13 Tablespoon/Powder 14 Softgel 16 Tablespoon/Liquid 17 Tablet 18 Teaspoon/Liquid 19 Wafer 20 Ounce/Powder 21 Spray/Squirt 22 Scoop/Powder 24 Cup/Powder 25 Chew 27 Other 28 Vegicap 29 Can/Liquid 30 Capful 31 Gumball 32 Gram/Powder 33 Teaspoon/Powder 34 Can/Powder 35 Scoop/Liquid 36 Cup/Liquid 37 Gram/Liquid 38 Drop/Lozenge 39 Unknown Dosage Form 99


Q.23 What was the strength per antacid tablet/pill/etc?


Q.24 Between midnight and midnight, how much of a dose did you take? (Ex: 2 gelcaps)

*List number of antacids taken and then form listed below. *Number taken, then type. (Example: 4, 6 = means they took 4 lozenges)






Q.24A. What is your usual dosage? (Ex: 2 gelcaps)


Q.24A.1a…f _________________________ REFUSED ...................................................... 7 DON'T KNOW ................................................ 9




DROPPERS ................................................... 2 DROPS .......................................................... 3 INJECTIONS/SHOTS .................................... 5 LOZENGES/COUGH DROPS ....................... 6 MILLILITERS ................................................. 7 POWDER/GRANULES .............................. … 10 TABLESPOONS ............................................ 11 TEASPOONS ................................................ 12 WAFERS ....................................................... 13 CANS ............................................................. 15 GRAMS .......................................................... 16 DOTS ............................................................. 17 CUPS ............................................................. 18 SPRAYS/SQUIRTS ....................................... 19 CHEWS/GUMMIES ....................................... 20 SCOOPS ....................................................... 21 CC ................................................................. 22 CAPFULS ...................................................... 23 MG ................................................................. 24 UNITS ............................................................ 25 GULP ............................................................. 26 OUNCES ....................................................... 27 PACKAGES/PACKETS ................................. 28 VIALS ............................................................. 29 GUMBALLS ................................................... 30 OTHER FORM (SPECIFY) ............................ 91 REFUSED ...................................................... 77 DON’T KNOW 99


Q.25 Did you take it yesterday? YES or NO Q.26 For how long have you been taking the antacid? ENTER NUMBER AND UNIT (DAYS, WEEKS, MONTHS OR YEARS)

Q26.1a(Ex. 3 years) …f _______________

_____Days _______Months _______Years DAYS ............................................................. 1 WEEKS .......................................................... 2 MONTHS ....................................................... 3 YEARS ........................................................... 4 OTHER .......................................................... 5

Q.26A Do you take it daily? YES or NO Q.26B If NO (not daily), how often? ENTER NUMBER AND UNIT (DAYS, WEEKS, MONTHS, or YEARS)

Q26B.1a (EX. 2 days per week)…f _______ Q.27 Did you decide to take {INSERT PRODUCT NAME} for reasons of your own or did a doctor or other health provider tell

you to take it?

Q27.1a…f __________________________





Q.28 For what reason or reasons do you take or the doctor or other health professional tell you to take {PRODUCT}?

Q28.1a…f __________________________








Q.29 Any other antacids (such as rolaids, tums, or pepsid AC)? Circle YES or No (If yes repeat Q17 – Q29) If no, proceed to

Q30. PRESCRIPTION VITAMINS, MINERALS AND ANTACIDS Interviewer Instruction: Now I am going to be asking you a few questions about your use of prescription vitamins, and/or minerals, antacids, and supplement injections. Q.30 Do you have the containers for all the prescription supplements that you’ve used yesterday

available in front of you? (If NO ask SP to go get the containers)


Q.31 All day yesterday, between midnight and midnight, did you take any prescription vitamins, minerals, antacids, or receive any prescription supplement injections? Circle: YES or NO


Interviewer Instructions: First I am going to ask you some questions about INSERT NAME OF PRESCRIPTION) that you took yesterday. Q. 32 What appears on the front label of the prescription supplement or antacid you took? Can you please read me all the words on the front label, if available?

Q32.1a….f _______________________________ ENTER SUPPLEMENT NAME REFUSED ...................................................... 7 DON'T KNOW ................................................ 9



Q.34 What was the form of the supplement taken? (Ex: pill, tablet, liquid etc.)

.................................................................

Q34.1a…f __________________________

Label Code Caplet 1 Capsule 2 Dropper 3 Drop 4 Fluid Ounce 5 Gel Cap 6 Injection/Shot 8 Lozenge 9 Milliliter 10 Package/Packet 12 Pill 13 Tablespoon/Powder 14 Softgel 16 Tablespoon/Liquid 17 Tablet 18 Teaspoon/Liquid 19 Wafer 20 Ounce/Powder 21 Spray/Squirt 22 Scoop/Powder 24 Cup/Powder 25 Chew 27 Other 28


Vegicap 29 Can/Liquid 30 Capful 31 Gumball 32 Gram/Powder 33 Teaspoon/Powder 34 Can/Powder 35 Scoop/Liquid 36 Cup/Liquid 37 Gram/Liquid 38 Drop/Lozenge 39 Unknown Dosage Form 99


Q.35 What was the strength per prescription tablet/pill/etc? Please if it is a double/triple element ask for the strength of each element.


Q.36 Between midnight and midnight, how much of a dose did you take? (Ex: 2 gelcaps) *List number of prescription supplements taken and then form listed below.

*Number taken, then type. (Example: 4, 6 = means they took 4 lozenges)

Q36.1a…f __________________________ REFUSED ...................................................... 7 DON'T KNOW …………………………………... 9






Q.37 How long have you been taking the prescription supplement/antacid? ENTER NUMBER AND UNIT (DAYS, WEEKS, MONTHS OR YEARS)

Q37.1a…f __________________________

_______Days _______Months ________Years

DAYS ............................................................. 1 WEEKS .......................................................... 2 MONTHS ....................................................... 3 YEARS ........................................................... 4 OTHER .......................................................... 5

Q.38A Do you take it daily? YES or NO Q.38B If NO (not daily), how often? ENTER NUMBER AND UNIT (DAYS, WEEKS, MONTHS, or YEARS)

Q38B.1a (EX. 2 days per week)…f _______

Q.39 Did you decide to take {INSERT PRODUCT NAME} for reasons of your own or did a doctor or other health provider tell

you to take it? Q39.1a…f __________________________





Q.40 For what reason or reasons do you take or the doctor or other health professional tell you to take {PRODUCT}?

Q40.1a…f __________________________








Q.41 Any other prescription supplements or antacids? Circle Yes or No (If yes repeat Q31-41) When list is complete review total number of dietary supplements and antacids and their names with respondent, then proceed to Q42


Q. 42 Who was the main respondent for this interview?

Sample person 1 Mother of sample person 2 Father of sample person 3 Wife of sample person 4 Husband of sample person 5 Daughter of SP 6 Son of SP 7 Friend, partner, non relative 8 Care provider or caretaker 9 Other relative 10 Other, specify 11

Q.43 Who else helped in responding for this interview? Yes 1 No 2 If yes, Sample person 1

Mother of sample person 2 Father of sample person 3 Wife of sample person 4 Husband of sample person 5 Daughter of SP 6 Son of SP 7

Grandchild of SP 8 Friend, partner, non relative 9 Care provider or caretaker 10 Other relative 11 Other, specify 12

Q. 44 Did you or the respondent have difficulty or any comments about this supplement interview?

Yes 1 No 2 If no....questionnaire ends

If yes....What were the reasons for this difficulty or comments about this interview?

Did not understand questions 1 Not familiar with handcards 2 Did not have handcards 3 Poor memory of supplements taken 4 Sick 5 Hearing impairment 6 Telephone connection problems 7 Interruptions 8 Uncooperative/impatient 9 Distracted/uninterested 10 Supplement list may be incomplete (explain in remark box) 11 Unreliable (explain in remark box) 12 Not ascertained 13 Other specify (explain in remark box) 14





Appendix 3: Matching Codes

1. Exact or near exact match; this is the only product that could match this entry. 2. Probable match; the match is not exact, but knowledge of the company’s products strongly suggests that this is the only possible match choice. For example the entry may not specify strength or include words such as timed release, but no other options are available for this brand according to manufacturer or retailer information. 3. Generic match; product has known strength for all ingredients, either a) as part of name (e.g. vitamin C 500 mg) or b) because the manufacturer is known. Thus the ingredients and amounts are considered to be accurate despite an exact brand match. 4. Reasonable match; the product name may be incomplete or could be complete but other products of this brand also start with these same words so this cannot be assured. In these cases, the entered name is matched to either: a) the most frequently reported of these products in the NHANES 2003-2004 data until HANDLS database expands, if this could be determined; b) the best selling product by this company that matches the entered name; or c) the most basic product by this company, as assessed by label wording. 5. Default match; the exact product could not be obtained because the name was imprecise or the exact brand product could not be located and no generic could be assigned. In these cases, the entered product was matched to a created default product based upon: a) the most commonly reported strengths for single ingredients; b) the most commonly reported brands for major multiple ingredient products such as multivitamins and multivitamin/multiminerals for children, seniors, or adults, if available; or c) products manufactured by a large, private-label manufacturer. According to NHANES 1999-2000 data and sales data indicate that far more people take multivitamin/multiminerals rather than just multivitamins; that numerous supplement labels calling a product a multivitamin actually also contain minerals; and that products that only exist as multivitamin/minerals are often named by NHANES participants as multivitamins, supplements recorded as multivitamins without further identifying information are matched to multivitamin/multiminerals, not multivitamins.

6. No match; no product could be found and there was not enough detail in the name to assign a generic or default match with any confidence. The words “no product information available” are listed as the product name. 7. Refused; product name was refused. 8. Don’t know; product name was not known.


Appendix 4: NHANES Created Default Supplements and Antacids

Default Supplement Assigned Strength or Supplement

Selection of Assigned Strength or Supplement Based On:

Alfalfa 500 mg Most Commonly Reported Strength

Aloe Vera Gel 25 mg Commonly Available Strength

B 50 B-Complex Vitasmart B 50 B-Complex Commonly Available Product

Balanced B 100 B-Complex Vitasmart Balanced B 100 B-Complex

Commonly Available Product

B-Complex With Vitamin C Nature Made B-Complex With Commonly Available Product Vitamin C

Beta Carotene 25,000 IU Most Commonly Reported Strength

Betaine Hydrochloride 650 mg Commonly Available Strength

Bilberry 80 mg Commonly Available Strength

Biotin 1000 mcg Commonly Available Strength

Black Cohosh 540 mg Most Commonly Reported Strength

Calcium 600 mg Most Commonly Reported Strength

Calcium & Magnesium Calcium 1000 mg, Magnesium 500 mg

Commonly Available Strength

Calcium + Magnesium 125 mg

Calcium 250 mg, Magnesium 125 mg


Calcium + Magnesium Liquid Calcium 1000 mg, Magnesium 500 mg


Calcium + Soy Caltrate 600 + Soy with Soy Isoflavones



Appendix 4: NHANES Created Default Supplements and Antacids, continued



Calcium + Vitamin D 125 IU Calcium 500 mg, Vitamin D 125 IU

Most Commonly Reported Strength

Calcium 250 mg With Vitamin D

Calcium 250 mg, Vitamin D 125 IU














Calcium Magnesium & Zinc Vitasmart Calcium Magnesium & Zinc


Calcium Polycarbophil Caplets

Fibercon Commonly Available Product

Calcium With Vitamin D Calcium 600 mg, Vitamin D 200 IU


Chewable Multivitamin With Fluoride

Copley Chewable Multivitamin With Fluoride (1mg)






Children’s Multivitamin/Multimineral

Flintstones Complete Children’s Multivitamin/Multimineral


Children’s Multivitamins Plus Iron

Flintstones Plus Iron Children’s Multivitamins


Chromium Picolinate Chromium 200 mcg Most Commonly Reported Strength

Cod Liver Oil Softgels Vitasmart Cod Liver Oil Softgels


Coenzyme Q-10 50 mg Most Commonly Reported Strength

Copper 2 mg Commonly Available Strength

Cranberry 300 mg Commonly Available Strength

Creatine Monohydrate 5000 mg (5 G) Most Commonly Reported Strength

Daily Multiple Vitamins Plus Iron

Perrigo Daily Multiple Vitamins Plus Iron


Dairy Digestive Caplets Lactaid Original Formula Commonly Available Product

Echinacea 400 mg Most Commonly Reported Strength

Echinacea & Goldenseal Echinacea 100 mg, Goldenseal 100 mg


Ester-C Your Life Ester-C 500 mg With Bioflavonoids


Fat Burner Weider Fat Burners Commonly Available Product

Fish Oil 1000 mg Most Commonly Reported Strength





Flax Seed Oil 1000 mg Commonly Available Strength

Flaxseed and Borage Oil Spectrum Essentials Flax Borage Oil


Fluoride Tabs Sodium Fluoride 1.1 mg Commonly Available Strength

Folic Acid 400 mcg Most Commonly Reported Strength

Garlic 500 mg Most Commonly Reported Strength

Gelatin 600 mg Commonly Available Strength

Ginkgo Biloba 60 mg Most Commonly Reported Strength

Ginseng 500 mg Most Commonly Reported Strength

Glucosamine 500 mg Commonly Available Strength

Glucosamine Chondroitin Glucosamine 500 mg, Chondroitin 400 mg


Glucosamine Chondroitin & MSM

Spring Valley Glucosamine Chondroitin Plus MSM


Grapeseed Extract 150 mg Most Commonly Reported Strength

Gummy Bear Multivitamin L'il Critters Gummy Vites Commonly Available Product

Iron 65 mg Most Commonly Reported Strength

Lactobacillus Acidophilus 10 mg Commonly Available Strength





Lecithin 1200 mg Most Commonly Reported Strength

Liquid Colloidal Minerals GNC Liquid Multi Colloidal Minerals


Lysine 500 mg Most Commonly Reported Strength

Magnesium 250 mg Most Commonly Reported Strength

Men’s Multivitamin/Multimineral

One A Day Men’s Health Formula

Most Commonly Reported Product

MSM 1000 mg Most Commonly Reported Strength

Multivitamin / Multimineral Centrum Advanced Formula High Potency Multivitamin Multimineral with Lutein / Lycopene


Multivitamin And Fluoride Drops

Enfamil Poly-Vi-Flor 0.25 mg Multivitamin And Fluoride Drops


Multivitamin Plus Iron The Medicine Shoppe Daily Multiple Vitamins Plus Iron


Niacin (Vitamin B-3) 500 mg Most Commonly Reported Strength

PABA 100 mg Commonly Available Strength

Pantothenic Acid (Vitamin B-5)

250 mg Most Commonly Reported Strength

Pediatric Iron Drops Fer-In-Sol Iron Drops Commonly Available Product





Polyvitamin And Fluoride Chewable Tablets

Enfamil Poly-Vi-Flor 0.25 mg Multivitamin And Fluoride Chewable Tablets


Polyvitamin Chewable Tablets

Enfamil Poly-Vi-Sol Multivitamin Chewable Tablets


Poly-Vitamin Drops Enfamil Poly-Vi-Sol Vitamin Drops


Potassium 99 mg Most Commonly Reported Strength

Prenatal Vitamins Stuart Prenatal Vitamins Commonly Available Product

Protein Powder GNC Pro Performance 100% Whey Protein Instantized, Chocolate Powder


Psyllium Fiber Metamucil Powder Original Texture Regular Flavor Dietary Fiber


Saw Palmetto 160 mg Commonly Available Strength

Selenium 200 mcg Most Commonly Reported Strength

Senior Multivitamin / Multimineral

Centrum Silver Multivitamin / Multimineral For Adults 50+ From A To Zinc with Lutein / Lycopene


Shark Cartilage 500 mg Commonly Available Strength

Siberian Ginseng 500 mg Commonly Available Strength

Sodium Fluoride Drops Teva Sodium Fluoride Drops Rx Only (0.25 mg)






St. John’s Wort 300 mg Most Commonly Reported Strength

Stress Vitamins Perrigo Stress Formula High Potency Stress Formula Vitamins


Tri-Vitamin Drops Enfamil Tri-Vi-Sol Vitamins A, D, & C Drops


Tri-Vitamin With Fluoride Drops

Enfamil Tri-Vi-Flor 0.25 mg Most Commonly Reported Vitamins A, D, C And Fluoride Product Drops

Vitamin A 10,000 IU Most Commonly Reported Strength

Vitamin A & D Vitamin A 1000 IU, Vitamin D 400 IU


Vitamin A 5000 IU + Vitamin D

Vitamin A 5000 IU, Vitamin D 400 IU


Vitamin B-1 (Thiamin) 100 mg Most Commonly Reported Strength

Vitamin B-12 500 mcg Most Commonly Reported Strength

Vitamin B-6 100 mg Most Commonly Reported Strength

Vitamin B-Complex Member’s Mark Vitamin B-Complex


Vitamin C 500 mg Most Commonly Reported Strength

Vitamin D 400 IU Most Commonly Reported Strength





Vitamin D Liquid 400 IU Commonly Available Strength

Vitamin E 400 IU Most Commonly Reported Strength

Vitamins C & E Vitamin C 500 mg, Vitamin E 400 IU


Whey Protein GNC Pro Performance 100% Whey Protein


Zinc 50 mg Most Commonly Reported Strength

Default Antacid Antacid Assigned Selection of Assigned Antacid Based On:

Default Antacid Anti-Gas Liquid

Mylanta Regular Strength Antacid Anti-Gas Liquid


Default Antacid Liquid Maalox Antacid Liquid Commonly Available Product

Default Calcium Antacid Tums Regular Strength Commonly Available Product

Default Calcium and Magnesium Antacid Tablets

Rolaids Original Antacid Commonly Available Product

Default Calcium Antacid Maximum Strength Tablets

Tums Ultra Maximum Strength



Appendix 5: Source of Supplement Information

Code Label 1 Manufacturer 2 Directly from Distributor 4 Inferred from supplement name 5 Physician’s Desk reference (PDR) 7 Product Catalog 8 Internet Listing 9 Supplement Label 10 Supplement from the same manufacturer 11 NHANES- for generic and default

Some numbers are skipped intentionally as the associated sources weren’t used.

Appendix 6: Formulation Type

Code Label 1 Standard formulation 2 Mature formulation (formulation for older adults) 3 Prenatal formulation 4 Pediatric


Appendix 7: Rules For Classifying Ingredients VITAMINS

An ingredient is classified as a vitamin if it is: • A single vitamin listed by its name (e.g. vitamin A) • A standard chemical form of the vitamin (retinol, retinal, retinoic acid) in

synthetic or natural form A vitamin will be classified as Other when it exists as:

• A precursor or provitamin to the active form of the vitamin (e.g. 7- dehydrocholesterol, a precursor to Vitamin D)

• A complex, since the ingredient content is unclear (e.g. B-complex) The following appear in supplements as a source of vitamins and are therefore classified as a vitamin:

• Vitamin A: palmitate, vitamin A acetate, vitamin A palmitate • Vitamin B-1/Thiamin: thiamin monophosphate or TMP, thiamin

mononitrate, thiamin hydrochloride • Vitamin B-2/Riboflavin: riboflavin mononitrate, riboflavin-5-phosphate

sodium • Vitamin B-3/Niacin • Vitamin B-5/Pantothenic Acid: pantothenate, calcium pantothenate • Vitamin B-6: pyridoxine hydrochloride, vitamin B6 hydrochloride • Vitamin B-12/Cobalamin: cyanocobalamin • Vitamin C/Ascorbic Acid: ascorbyl palmitate, sodium ascorbate • Vitamin D/Calciferol: cholecalciferol, ergocalciferol, calcitriol • Vitamin E/Tocopherol: d-alpha tocopheryl acid succinate, dl-alpha

tocopheryl acetate, d-alpha tocopheryl acetate, d-alpha tocopherol, d-alpha tocopheryl, tocopherols, mixed tocopherols, vitamin E acetate, tocotrienol

• Vitamin K/Menadione: phytonadione • Biotin: Choline, choline bitartrate • Folic Acid/Folate


Appendix 7: Rules For Classifying Ingredients, continued MINERALS An ingredient is classified as a mineral if it is a macro or micromineral (trace element):

• in its elemental form (e.g. iron) • is the source of the mineral in a supplement (e.g. ferrous gluconate,

potassium iodide, nickel chloride). An ingredient containing a mineral is classified as Other when it is:

• an enzyme (e.g. boron protease) • a complex, since the ingredient content is unclear (e.g. Trace Mineral

Complex) • used as an electrolyte (chloride, potassium, sodium)

The following are Arsenic Barium Boron Bromine Cadmium Calcium Chromium Cobalt

classified as minerals: Copper Fluoride Iodine Iron Magnesium Manganese Molybdenum Nickel

Phosphorus Selenium Silicon Strontium Sulfur Tin Vanadium Zinc

BOTANICALS An ingredient is classified as a botanical if it is:

• part of a plant, tree, shrub, herb, algae etc. Botanicals may include the following words:

• Extract, Powder • Leaf, Root, Flower, Stem, Peel, Fruit • Component of a botanical that specifically mentions it is from the plant

(e.g. soy isoflavones, citrus bioflavonoids)

An ingredient containing a botanical is classified as Other if it is: • listed only as an unspecified blend • a chemical structure derived originally from a botanical (e.g.

bromelain, the enzyme found in pineapple; Alliin, a phytochemical in garlic; apple cider vinegar)


Appendix 7: Rules For Classifying Ingredients, continued AMINO ACIDS AND PROTEIN

An ingredient is classified as an amino acid if it is an essential or nonessential amino acid. It can exist in:

• it’s free form (e.g. lycine, glutamine) • its post-translational form with one or two added groups (e.g.Cystine,

Hydroxyl sine, Hydroxyproline, Dimethylglycine, and 3-methylhistidine) • one of its isomeric forms (e.g. l-tyrosine) • the source of an amino acid in a supplement (e.g. l-lysine

monohydrochloride, glutamic acid hydrochloride)

An amino acid would be classified as Other if it is: • in its post-translational form with three or more added groups

(Trimethylglycine, Tetramethylglycine, etc.) • an alpha-keto acid (an amino acid with its amino group, NH3, replaced by

a keto group) (e.g. "-ketoglutarate) • a residue of an amino acid ((-carboxyglutamic acid also known as

GLA) • as a complex of amino acids (e.g. natural amino acid complex), since the

ingredient content is unclear

The following are classified as amino acids: Alanine Glycine Proline Arginine Histidine Serine Asparagine Isoleucine Taurine Aspartic Acid Leucine Threonine Cysteine Lysine Tryptophan Glutamic Acid Methionine Tyrosine Glutamine Phenylalanine Valine


FATS

The following are examples of would be classified as a fat:

Fish oils, cholesterol

FIBER

CARBOHYDRATES AND SUGAR

Appendix 7: Rules For Classifying Ingredients, continued

OTHER The following are examples of ingredients that would be classified as other:

an electrolyte (e.g. chloride, potassium, sodium) a hormone (e.g. DHEA), unless if it is the active form of a vitamin (calcitriol) an enzyme (e.g. cellulase, glucoamylase) Complexes and blends (unless all components are of the same type ex. amino acid blend) Bioflavonoids and Isoflavones (if not associated with a plant, in which case it would be classified as a Botanical Vinegars Phytochemicals (e.g. lutein, allin) Vitamin precursors, e.g. some carotenoids


Appendix 8: Reported Dosage Units

Code Label

1 Tablets, capsules, pills, caplets, softgels, gelcaps, vegicaps

2 Droppers

3 Drops

5 Injections/Shots

6 Lozenges

7 Milliliters

10 Powder/Granules

11 Tablespoons

12 Teaspoons

13 Wafers

15 Cans

16 Grams

17 Dots

18 Cups

19 Sprays/Squirts

20 Chews

21 Scoop

22 CC

23 Capful

24 MG

25 Units

26 Gulp

27 Ounces


Appendix 8: Reported Serving Size Units, continued

Code Label

28 Packages/Packets

29 Vial

30 Gumball


Appendix 9: Reasons for Taking Supplements Code Label 10 For good bowel/colon health

11 For prostate health

12 For mental health, dementia, memory

13 To prevent health problems

14 To improve my overall health, nails, hair, cleanse, liver

15 For teeth, prevent cavities

16 To supplement diet because I don’t get enough from food

17 To maintain health to stay healthy

18 To prevent colds, boost immune system

19 For heart health, cholesterol, circulation, blood pressure, triglycerides,

Elevated CRP, omega 3

20 For eye health, macular degeneration

21 For healthy joints, arthritis

22 For skin health, dry skin

23 For weight loss, lap band surgery, gastric bypass surgery

24 For bone health, build strong bones, osteoporosis

25 To get more energy

26 For pregnancy

27 For anemia, such as low iron, low folate

28 Lactose intolerance

29 Acid reflux, GERD, heartburn, indigestion 30 Vitamin inadequacy or deficiency (Vitamins B12, D) 31 Women’s health, breast cancer, cancer survivor, hot flashes 32 Diabetes 33 Gastrointestinal health (fiber, probiotics)


34 Doctor recommended 37 Muscle strength, to gain muscle mass, fitness 38 For kidney health, dialysis, urinary tract infection 39 Muscle cramps 91 Other specify

77 Refused

99 Don’t know


Appendix 10: Label Serving Size Units

Code Label

1 Caplet

2 Capsule

3 Dropper

4 Drop

5 Fluid Ounce

6 Gel Cap

8 Injection/Shot

9 Lozenge

10 Milliliter

12 Package/Packet

13 Pill

14 Tablespoon/Powder

16 Softgel

17 Tablespoon/Liquid

18 Tablet

19 Teaspoon/Liquid

20 Wafer


Appendix 10: Label Serving Size Units, continued

Code Label

21 Ounce/Powder

22 Spray/Squirt

24 Scoop/Powder

25 Cup/Powder

27 Chew

28 Other

29 Vegicap

30 Can/Liquid

31 Capful

32 Gumball

33 Gram/Powder

34 Teaspoon/Powder

35 Can/Powder

36 Scoop/Liquid

37 Cup/Liquid

38 Gram/Liquid

39 Drop/Lozenge

99 Unknown Dosage Form


Appendix 11: Ingredient Units

Code Label

1 mg

2 IU

3 %

4 mcg

5 gm

6 mL

7 Kcal

8 DU

9 HUT

10 LU

11 CU

12 endo-PGO

13 AGU

14 PPM

15 Million

16 Billion

17 LacU

18 X

19 PPB

20 Trace

21 Unknown

22 PU

23 SEU

24 InvU


Appendix 11: Ingredient Units, continued

Code Label

25 °DP

26 HCU

27 GFU

28 GALU

29 ALU

30 FTU

31 NG

Appendix 12: Ingredient Classification

Code Label 1 Vitamin 2 Mineral 3 Botanical 4 Other 5 Amino Acid 6 Fat 7 Fiber 8 Carbohydrate, Sugar


Appendix 13: Description of Statistical Analysis to Create Supplemental Nutrient File Supplemental nutrient intake was estimated using information provided from several

ingredient-level, supplement and individual-level databases, by going through the following

steps: (A) A “nutrient ingredient” file (File 4) which is an ingredient-level database was

manipulated to obtain separate variables estimating the quantity of each of the nutrients of

interest within each supplement ID, after standardizing the unit of the quantity per nutrient. The

same database was also manipulated to generate variables determining the category of each

supplement ID (e.g. mineral supplement: 0=no, 1=yes) (B) The “nutrient ingredient” file was

then collapsed by supplement ID, summing up both the nutrient quantities and the category to

obtain a single record per supplement ID, making it a supplement-level database (collapsed File

4); (C) The collapsed file was then merged with the supplement-level database “supplement

information” (File 3); (D) The file that combines collapsed File 4 with File 3 was then merged

by supplement ID with an individual-level database describing reasons for use of each

supplements as well as dosage and length (File 2: “Supplement Records”). The resulting file

was named collapsedFile4_File3_File2 (E) File 2 (Supplement Records) was then merged

with File 1 (Supplement counts) by individual-level ID, to create the length variables for using

each of category of supplements (i.e. days of use of OTC, antacid and prescription supplements).

This was done by collapsing the file by individual-level ID and averaging out the days of use per

individual. The resulting file is named File1_File2_length. (F) collapsedFile4_File3_File2 was

then merged by individual-level ID with File1_File2_length and with File1. The resulting file

was named files1_2_3_4_collapse_merged; (G) Using the last merged file in (F) (supplement-

level and individual-level database), a number of variables were created and those were: G.1.

Daily intake of each nutrient: This was done by multiplying the amount of the nutrient in each


supplement by the quantity used per individual and dividing that value by the serving quantity to

obtain a standardized amount per individual and per supplement. If the individual did not use a

supplement with a specific nutrient, the value was entered as zero; G.2. Daily intake × length of

each nutrient: This set of variables was computed by multiplying daily intake of each nutrient

with the length of use within each supplement and each individual; G.3. Length of use (in days)

of each nutrient: This set of variables was computed by assigning length of use in days to each

supplement and each individual whenever daily use of a specific nutrient was >0; G.4. Reason

for use of each supplement. A set of 36 binary variables (yes/no) were created per supplement

and per individual denoting whether the supplement used by a specific individual was used for a

certain pre-coded reason. (H) For the data to be usable, a series of data management procedures

were done to sum up or average values of variables created in previous steps across supplement

IDs and within each individual-level ID. Prior to this step, the database obtained in (G) was sub-

set to day 1 and day 2 of intakes in wave 3. Within each day, collapsing by individual-level ID

was done as follows: (H.1.) Means: mean days of use of OTC, antacid and prescription

supplements, use of each of those categories (yes/no) and count of each of those categories;

(H.2) Summation: Variables created in G.1., G.2., G.3. and G.4. The same process was done

for day 2 of intake (I) The resulting databases which are individual-level were appended and

each variable was averaged by individual-level ID to obtain a final dataset with all usable

variables; (J) Reasons for supplement use were combined after examining their individual

frequency distributions for the purpose of simplicity. All variables were labelled including

units.

Documents

Healthy Aging in Neighborhoods of Diversity across the ...€¦ · The Dietary Supplements section provides personal interview data on use of over the counter and prescription vitamins,